Board of Directors Meeting December Director of Nursing Report

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1 Board of Directors Meeting December 2014 Director of Nursing Report Monthly Report of Nurse Midwifery Staffing Levels 1 November November 2014 Executive Summary Purpose: To provide the board with an overview of nurse midwifery ing levels in inpatient areas as outlined in the Nurse Staff Guide How to ensure the right people, with the right skills are in the right place at the right time! Published by the National Quality Board and NHS Commissioning Board. To provide the Board with an overview of nurse midwifery shifts not covered, vacancies and sickness rates. To bring to the attention of the board any workforce risks. Methodology and scope of review: This report is focused on the following areas: All in-patient adult wards including critical care All in-patient maternity wards and departments on the acute site All in-patient paediatric wards including neonates This report does not yet include non-in-patient areas such as the operating theatres, day surgery, endoscopy and emergency department. At the present time there is no requirement to report the and numbers of ing for our escalation ward or bays. Key Points: To demonstrate compliance with new ing expectations and ing guidance. Ward establishments are based on evidence based assessments of acuity and dependency which is recorded on Swiftplus, alongside professional judgment and key clinical indicators. The Trust has utilised the (Association of UK University Hospitals (AUKUH) tool for a number of years. The Trust is currently reviewing and testing different Safer Nursing Care tools to ensure the right methodology for the workforce establishment review is utilised. Testing has commenced using the Shelford Safer Nursing Care tool. We are now collecting the number of times shifts fell below agreed ing levels, as this is currently being undertaken manually there may be slight inaccuracies in the data. It is expected we will be able to automate this by Spring 2015, following the purchase of the E-Rostering software, Allocate and the Safecare Module. Staffing during November was again challenging, due to high acuity, vacancies and sickness, however 1226 shifts were covered by bank and agency. Staff were also moved from wards following professional clinical judgment, this would have been possible due to low patient numbers on a ward, for example Kingston Wing, therefore allowing for moves.

2 NICE guidance Safe Staffing for nursing in adult inpatients wards in acute hospitals was published in July 2014 and the Trust will be drawing up a safer ing project plan to work through the guidance across the adult inpatient wards. In October 2014 NICE issued draft guidelines for safe midwifery ing in maternity settings, the consultation period closed on 13 November The final guideline is expected to be published in February NHS England published a paper on 26 November 2014 in relation to Safer Staffing: A guide to Care Contact Time. The guidance provides a suite of toolkits to support organisations in making decisions to ensure safe ing care for patients and service users. From 1 December 2014 an Associate Director of Nursing will be working with the HR and nursing teams to lead the recruitment and retention of nurses, managing the temporary ing office and overseeing e-rostering and safer ing.

3 The national return on Unify for the month of November 2014, demonstrated that Ward 6B was the highest ed area with 118.3% during the day with care and the lowest ed area was SCBU with 76.7% of registered during the day. The Trust s overall return was 101.1%. Day Night Day Night Ward name Registered midwives/nurses Care Staff Registered midwives/nurses Care Staff Average fill rate - registered nurses/midwives (%) Average fill rate - care (%) Average fill rate - registered nurses/midwives (%) Average fill rate - care (%) Jasmine % 96.5% 98.5% 96.9% Kingston Wing % 103.4% 98.3% 103.3% 6A % 106.4% 101.7% 116.1% 6B % 112.8% 118.3% 108.3% 7A % 99.5% 100.0% 100.0% EAU % 102.8% 104.4% 100.0% 8A % 103.1% 100.0% 103.3% 8B % 111.3% 100.0% 108.3% 9A % 120.0% 100.0% 100.0% 9B % 100.4% 100.0% 103.3% % 100.0% 98.9% ICU % 104.0% 99.5% CCU % 100.0% Freya % 99.2% 93.7% 96.7% SCBU % 76.7% 96.7% 96.1%

4 When the data is broken down on a shift by shift basis, there were a total of 174 shifts which were not covered in the month of November. 48 HCA shifts during the day not covered (41 due to no being available and 7 due to sickness). 7 HCA shifts during the night (5 non one available to cover and 2 due to sickness). 10 HCA shifts on the Maternity Unit during the day not covered due to sickness and no available. 2 night shifts not covered due to sickness and no available on the Maternity Unit. 54 Registered Nurse shifts during the day (40 unable to cover shift, 13 due to sickness and 1 DNA) 5 Registered Nurse shift during the night (3 no one available and 2 due to sickness 37 Midwifery shifts not covered during the day no one available 11 shifts at night no covered - no available on the Maternity unit. Ongoing work continues with the Nurse Bank to ensure that where shifts have not been covered that the reason why is clearly documented, so that Board can be fully informed of ing shortfalls. Ward Staffing Boards are now in place on all in-patient wards which records the number of registered nurses, health care assistants and therapy with the on duty, this is recorded for early, late and night shifts. Acuity, dependency and complexity of patients is escalated to senior nursing and midwifery teams and if a change in ing skill mix is required in order to meet the acuity needs of patients this is actioned in order to maintain patient safety. Where individual shifts triggered the acuity measure agreed Trust escalation process were triggered and contingency plans implemented. However ing levels remained safe with flexing of across wards and department, utilisation of temporary and the use of the specials team to care for the unwell patient requiring one to one care Vacancy levels vary across wards and departments. There is a continued central drive to recruit. 1 new nurses, 1 Clinical Research Nurse, 1 Sister, 1 Preceptorship Nurse and 2 return to practice nurses were appointed in November 2014 and interviews held for 12 nursing / nursing support positions. Staffing numbers versus published on each ward on a shift by shift basis, commenced May 2014 and is ongoing. Vacancy shortfall covered by the use of temporary Activity has risen at Yeovil maternity unit over the preceding six months leading to an increased midwife to birth ratio requiring us to review our agreed ing levels with the finance team and draw up a revised template in consideration of a long term plan to address the issue, we will ensure that the new template will follow the new NICE guidance expected in October In the short term we have some issues around sickness and maternity leave, to address this and move to towards the long term strategy around the new template we have very recently recruited 6 band 5 midwife preceptorship posts to capture the newly qualified midwifery students when available, 5 have already commenced work at the end of October so we hope to see an improvement in ing levels after their induction period ends by the beginning of December. We have also managed to recruit 2 more midwives to the bank who don t already work at this unit and some long term sickness is resolving positively. On a daily basis unit and on call ing of all grades is reviewed by the senior midwifery team and every effort is made to cover shortfalls where possible, are also encouraged to incident report all deficits and contact the on call supervisor when necessary. A piece of work has been commissioned testing the Safer Nursing Care Tool (Shelford Group 2013), this was an academic exercise and further testing will be undertaking to establish a model which incorporates professional judgment.

5 The following table shows the number of bank and agency used for the month of November 2014, which has been broken down by ward and specialty. A total of1226 bank and agency was used in November 2014 to cover shifts on the ward, of this 613 were agency and 613 were booked from the YDH bank. Jasmine Kingston 6A 6B 7A EAU 8A 8B 9A 9B 10 ICU CCU Freya HCA Agency A Agency D Grade Bank Band Bank Band Bank Band Bank Band 4 2 Bank Band Bank Band Agency Bank Labour Ward SCBU Implications: Planned recruitment campaign to reduce the need for temporary. New HR Manager started 2 September Continue to review nursing and midwifery ing levels and patient acuity on a shift by shift basis and establishment review commenced in September Where appropriate the Trust will work to the 1:8 ratio as recommended in the National Safe Staffing Alliance for relevant adult wards. Recommendations: The Board of Directors is asked to note the information contained in this summary report and the actions we have in place.

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